|
VANDUAR E1 PS TIB BRG 87/91*13
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUAR E1 PS TIB BRG 87/91*14
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUAR E1 PS TIB BRG 87/91*14
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUAR E1 PS TIB BRG 87/91*16
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUAR E1 PS TIB BRG 87/91*16
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUAR E1 PS TIB BRG 87/91*18
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUAR E1 PS TIB BRG 87/91*18
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUAR PSC TIB BRG S 10*63/67
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 10*63/67
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 10*71/75
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 10*71/75
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 12*63/67
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 12*63/67
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 12*71/75
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 12*71/75
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 14*63/67
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 14*63/67
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 14*71/75
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 14*71/75
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 16*63/67
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 16*63/67
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 16*71/75
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 16*71/75
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 18*63/67
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUAR PSC TIB BRG S 18*63/67
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
